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Surgical site infection following fasciotomy in patients with acute forearm compartment syndrome: a retrospective analysis of risk factors

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Fasciotomy, a standard therapy for acute forearm compartment syndrome (AFCS), can prevent serious complications, but there may be significant postoperative consequences. Surgical site infection (SSI) may cause fever, discomfort, and potentially fatal sepsis. This study aimed to identify risk factors for SSI in AFCS patients who had undergone fasciotomy.

Materials and methods

Patients with AFCS who had fasciotomies between November 2013 and January 2021 were recruited. We collected demographic information, comorbidities, and admission laboratory results. Analyses of continuous data were conducted using the t-test, the Mann–Whitney U test, and logistic regression analysis, while analyses of categorical data were conducted using the Chi-square and Fisher's exact tests.

Results

Sixteen AFCS patients (13.9%) suffered infections that need further therapy. Using the logistic regression analysis, we identified that patients with a history of diabetes (p = 0.028, OR = 16.353, 95% CI (1.357, 197.001)), open fractures (p = 0.026, OR = 5.239, 95% CI (1.223, 22.438)), and a higher level of TC (p = 0.004, OR = 4.871, 95% CI (1.654–14.350)) were the best predictors of SSI, while ALB levels (p = 0.004, OR = 0.776, 95% CI (0.653–0.924)) were protective for SSI in AFCS patients.

Conclusions

Our results showed that open fractures, diabetes, and TC levels were relevent risk factors for SSI following fasciotomy in patients with AFCS, allowing us to personalize the risk assessment and apply early targeted interventions.

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Availability of data and material

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Code availability

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Abbreviations

ACS:

Acute compartment syndrome

AFCS:

Acute forearm compartment syndrome

BMI:

Body mass index

ASA:

American Society of Anesthesiologists

HCT:

Hematocrit

BAS:

Basophil

MCH:

Mean corpusular hemoglobin

EOS:

Eosinophil

HGB:

Hemoglobin

IMM:

Immature

LYM:

Lymphocyte

MCHC:

Mean corpusular hemoglobin concentration

NEU:

Neutrophil

MON:

Monocyte

PLT:

Platelet

RBC:

Red blood cell

ALB:

Albumin

WBC:

White blood cell

ALP:

Alkaline phosphatase

GLU:

Glucose

AST:

Aspartate aminotransferase

ALT:

Alanine transaminase

TCO2:

Total carbon dioxide

Ca:

Calcium

CK:

Creatine kinase

GLOB:

Globulin

CHE:

Cholinesterase

CREA:

Creatinine

DBIL:

Direct bilirubin

LDH:

Lactic dehydrogenase

TG:

Triglyceride

TC:

Total cholesterol

UREA:

Ureophil

UA:

Uric acid

References

  1. Wang T, Guo J, Long Y, Hou Z. Predictors of acute compartment syndrome in patients with tibial fractures: a meta-analysis. Int Orthop. 2023. https://doi.org/10.1007/s00264-022-05643-3.

    Article  PubMed  Google Scholar 

  2. Torlincasi AM, Lopez RA, Waseem M. Acute compartment syndrome. 2022.

  3. McQueen MM, Gaston P, Court-Brown CM. Acute compartment syndrome. Who is at risk? J Bone Jt Surg Br. 2000;82:200–3.

    Article  CAS  Google Scholar 

  4. Kalyani BS, Fisher BE, Roberts CS, Giannoudis PV. Compartment syndrome of the forearm: a systematic review. J Hand Surg Am. 2011. https://doi.org/10.1016/j.jhsa.2010.12.007.

    Article  PubMed  Google Scholar 

  5. Janzing HM. Epidemiology, etiology, pathophysiology and diagnosis of the acute compartment syndrome of the extremity. Eur J Trauma Emerg Surg. 2007. https://doi.org/10.1007/s00068-007-7151-0.

    Article  PubMed  Google Scholar 

  6. Jensen SL, Sandermann J. Compartment syndrome and fasciotomy in vascular surgery. A review of 57 cases. Eur J Vasc Endovasc Surg. 1997. https://doi.org/10.1016/s1078-5884(97)80050-0.

    Article  PubMed  Google Scholar 

  7. Heemskerk J, Kitslaar P. Acute compartment syndrome of the lower leg: retrospective study on prevalence, technique, and outcome of fasciotomies. World J Surg. 2003. https://doi.org/10.1007/s00268-003-6691-7.

    Article  PubMed  Google Scholar 

  8. Magill SS, Edwards JR, Bamberg W, Beldavs ZG, Dumyati G, Kainer MA, et al. Multistate point-prevalence survey of health care-associated infections. N Engl J Med. 2014. https://doi.org/10.1056/NEJMoa1306801.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Velmahos GC, Theodorou D, Demetriades D, Chan L, Berne TV, Asensio J, et al. Complications and nonclosure rates of fasciotomy for trauma and related risk factors. World J Surg. 1997. https://doi.org/10.1007/s002689900224.

    Article  PubMed  Google Scholar 

  10. Whitesides TE, Heckman MM. Acute compartment syndrome: update on diagnosis and treatment. J Am Acad Orthop Surg. 1996. https://doi.org/10.5435/00124635-199607000-00005.

    Article  PubMed  Google Scholar 

  11. Savage JW, Anderson PA. An update on modifiable factors to reduce the risk of surgical site infections. Spine J. 2013. https://doi.org/10.1016/j.spinee.2013.03.051.

    Article  PubMed  Google Scholar 

  12. Badia JM, Casey AL, Petrosillo N, Hudson PM, Mitchell SA, Crosby C. Impact of surgical site infection on healthcare costs and patient outcomes: a systematic review in six European countries. J Hosp Infect. 2017. https://doi.org/10.1016/j.jhin.2017.03.004.

    Article  PubMed  Google Scholar 

  13. Dong X. Surgical site infection in upper extremity fracture: Incidence and prognostic risk factors. Medicine (Baltimore). 2022. https://doi.org/10.1097/MD.0000000000030460.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mangram AJ, Horan TC, Pearson ML, Silver LC, Jarvis WR. Guideline for prevention of surgical site infection, 1999. Centers for disease control and prevention (CDC) hospital infection control practices advisory committee. Am J Infect Control. 1999;27:97–132, 133–134, 96.

  15. Hines EM, Dowling S, Hegerty F, Pelecanos A, Tetsworth K. Bacterial infection of fasciotomy wounds following decompression for acute compartment syndrome. Injury. 2021. https://doi.org/10.1016/j.injury.2021.06.018.

    Article  PubMed  Google Scholar 

  16. Browne AC, Vearncombe M, Sibbald RG. High bacterial load in asymptomatic diabetic patients with neurotrophic ulcers retards wound healing after application of Dermagraft. Ostomy Wound Manage. 2001;47:44–9.

    CAS  PubMed  Google Scholar 

  17. Cutting KF, White RJ. Criteria for identifying wound infection–revisited. Ostomy Wound Manage. 2005;51:28–34.

    PubMed  Google Scholar 

  18. Guo J, Yin Y, Jin L, Zhang R, Hou Z, Zhang Y. Acute compartment syndrome: cause, diagnosis, and new viewpoint. Medicine (Baltimore). 2019. https://doi.org/10.1097/MD.0000000000016260.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Schmidt AH. Acute compartment syndrome. Injury. 2017. https://doi.org/10.1016/j.injury.2017.04.024.

    Article  PubMed  Google Scholar 

  20. Maffulli N, Loppini M, Spiezia F, D’Addona A, Maffulli GD. Single minimal incision fasciotomy for chronic exertional compartment syndrome of the lower leg. J Orthop Surg Res. 2016. https://doi.org/10.1186/s13018-016-0395-9.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Olsen MA, Nepple JJ, Riew KD, Lenke LG, Bridwell KH, Mayfield J, et al. Risk factors for surgical site infection following orthopaedic spinal operations. J Bone Jt Surg. 2008. https://doi.org/10.2106/JBJS.F.01515.

    Article  Google Scholar 

  22. Bykowski MR, Sivak WN, Cray J, Buterbaugh G, Imbriglia JE, Lee WP. Assessing the impact of antibiotic prophylaxis in outpatient elective hand surgery: a single-center, retrospective review of 8,850 cases. J Hand Surg Am. 2011. https://doi.org/10.1016/j.jhsa.2011.08.005.

    Article  PubMed  Google Scholar 

  23. Martin ET, Kaye KS, Knott C, Nguyen H, Santarossa M, Evans R, et al. Diabetes and risk of surgical site infection: a systematic review and meta-analysis. Infect Control Hosp Epidemiol. 2016. https://doi.org/10.1017/ice.2015.249.

    Article  PubMed  PubMed Central  Google Scholar 

  24. Brophy RH, Bansal A, Rogalski BL, Rizzo MG, Weiner EJ, Wolff BD, et al. Risk factors for surgical site infections after orthopaedic surgery in the ambulatory surgical center setting. J Am Acad Orthop Surg. 2019. https://doi.org/10.5435/JAAOS-D-17-00861.

    Article  PubMed  Google Scholar 

  25. Davidson NJ, Sowden JM, Fletcher J. Defective phagocytosis in insulin controlled diabetics: evidence for a reaction between glucose and opsonising proteins. J Clin Pathol. 1984. https://doi.org/10.1136/jcp.37.7.783.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Russo N. Perioperative glycemic control. Anesthesiol Clin. 2012. https://doi.org/10.1016/j.anclin.2012.07.007.

    Article  PubMed  Google Scholar 

  27. Ojo OD, Oluwadiya KS, Ikem IC, Oginni LM, Ako-Nai AK, Daniel FV. Superficial swab cultures in open fracture management: insights from a resource-poor setting. J Wound Care. 2010. https://doi.org/10.12968/jowc.2010.19.10.79090.

    Article  PubMed  Google Scholar 

  28. Ryan DJ, Minhas SV, Konda S, Catalano LW. surgical site infection after open upper extremity fracture and the effect of urgent operative intervention. J Orthop Trauma. 2020. https://doi.org/10.1097/BOT.0000000000001700.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Kortram K, Bezstarosti H, Metsemakers WJ, Raschke MJ, Van Lieshout E, Verhofstad M. Risk factors for infectious complications after open fractures; a systematic review and meta-analysis. Int Orthop. 2017. https://doi.org/10.1007/s00264-017-3556-5.

    Article  PubMed  Google Scholar 

  30. Maurer E, Wallmeier V, Reumann MK, Ehnert S, Ihle C, Schreiner AJ, et al. Risk of malnutrition in orthopedic trauma patients with surgical site infections is associated with increased morbidity and mortality—a 3-year follow-up study. Injury. 2020. https://doi.org/10.1016/j.injury.2020.06.019.

    Article  PubMed  Google Scholar 

  31. Nelson CL, Elkassabany NM, Kamath AF, Liu J. Low albumin levels, more than morbid obesity, are associated with complications after TKA. Clin Orthop Relat Res. 2015. https://doi.org/10.1007/s11999-015-4333-7.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Lee KC, Lee IO. Preoperative laboratory testing in elderly patients. Curr Opin Anaesthesiol. 2021. https://doi.org/10.1097/ACO.0000000000001008.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Jacobs D, Blackburn H, Higgins M, Reed D, Iso H, McMillan G, et al. Report of the conference on low blood cholesterol: mortality associations. Circulation. 1992. https://doi.org/10.1161/01.cir.86.3.1046.

    Article  PubMed  Google Scholar 

  34. Iribarren C, Jacobs DJ, Sidney S, Claxton AJ, Feingold KR. Cohort study of serum total cholesterol and in-hospital incidence of infectious diseases. Epidemiol Infect. 1998. https://doi.org/10.1017/s0950268898001435.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Canturk NZ, Canturk Z, Okay E, Yirmibesoglu O, Eraldemir B. Risk of nosocomial infections and effects of total cholesterol, HDL cholesterol in surgical patients. Clin Nutr. 2002. https://doi.org/10.1054/clnu.2002.0575.

    Article  PubMed  Google Scholar 

  36. Delgado-Rodriguez M, Medina-Cuadros M, Martinez-Gallego G, Sillero-Arenas M. Total cholesterol, HDL-cholesterol, and risk of nosocomial infection: a prospective study in surgical patients. Infect Control Hosp Epidemiol. 1997. https://doi.org/10.1086/647494.

    Article  PubMed  Google Scholar 

  37. Medina M, Sillero M, Martinez-Gallego G, Delgado-Rodriguez M. Risk factors of surgical wound infection in patients undergoing herniorrhaphy. Eur J Surg. 1997;163:191–8.

    CAS  PubMed  Google Scholar 

  38. Braunwald J, Nonnenmacher H, Pereira CA, Kirn A. Increased susceptibility to mouse hepatitis virus type 3 (MHV3) infection induced by a hypercholesterolaemic diet with increased adsorption of MHV3 to primary hepatocyte cultures. Res Virol. 1991. https://doi.org/10.1016/0923-2516(91)90022-u.

    Article  PubMed  PubMed Central  Google Scholar 

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Acknowledgements

Not applicable.

Funding

This research was funded by the Science and Technology Project and Intellectual Property Bureau of Baoding City, China, Grant Number 2041ZF260; the Natural Science Foundation of Hebei Province, China, Grant Number H2022104011; The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

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Author notes

  1. Ming An and Ruili Jia have contributed equally.

Authors and Affiliations

  1. Department of Orthopedics, The First Central Hospital of Baoding, Baoding, 071000, China

    Ming An, Hui Qi, Shuai Wang, Jingtian Ren & Yubin Long

  2. Department of Nephrology, The First Central Hospital of Baoding, Baoding, 071000, China

    Ruili Jia

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Contributions

MA and RLJ was responsible for study concept and writing the article. HQ and SW were responsible for screened the abstracts and reviewed the article. JTR and YBL was responsible for reviewing and writing the article.

Corresponding author

Correspondence to Yubin Long.

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Conflict of interest

Ming An, Ruili Jia, Hui Qi, Shuai Wang, Jingtian Ren, Yubin Long declare that they have no conflict of interest.

Ethics approval and consent to participate

This retrospective study was approved by the Institutional Review Board of our hospital (2022116) before collecting data. There is no need to write informed consent forms from patients because this is a retrospective study.

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An, M., Jia, R., Qi, H. et al. Surgical site infection following fasciotomy in patients with acute forearm compartment syndrome: a retrospective analysis of risk factors. Eur J Trauma Emerg Surg 49, 2129–2137 (2023). https://doi.org/10.1007/s00068-023-02294-w

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